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Vaginal Cysts and Masses

Vaginal cysts and masses span benign cystic, benign solid, premalignant, and malignant lesions of the vaginal wall and paravaginal tissues. The vast majority are benign and asymptomatic, with anterior-vaginal-wall cysts reported in roughly 0.5–1% of women[5]. The most common cystic lesions are Müllerian, epidermal inclusion and Gartner duct cysts; their proportions vary by sampled population. In a 126-patient referral or treatment series, urethral diverticula accounted for 39.7% and Skene cysts or abscesses for 30.2% of periurethral or anterior-wall masses.[1][2][3][4][5] Special attention belongs to masses in women over 40 or those that are fixed, painful, or bleeding; malignancy is rare but must be excluded.

For periurethral cystic masses and urethral meatal lesions, see also Female Urethral & Periurethral Masses and Urethral Diverticulum. For lichen-sclerosus-related vulvovaginal lesions, see Lichen Sclerosus. For the operative management of the most common anterior-wall mass, see Urethral Diverticulum Repair; for excision-defect coverage, see Vulvar Reconstruction.

Organizational Framework​

CategoryLesions
Embryologic cystsMüllerian, Gartner duct (mesonephric), Skene gland (paraurethral)
Acquired cystsEpidermal inclusion, endometriotic, Bartholin duct
UrologicUrethral diverticulum, ectopic ureterocele, ectopic ureter
Benign solid tumorsLeiomyoma, fibroepithelial stromal polyp, angiomyofibroblastoma, cellular angiofibroma, superficial myofibroblastoma
Locally aggressiveAggressive angiomyxoma
PremalignantVaginal intraepithelial neoplasia (VAIN / vaginal HSIL)
MalignantSquamous cell carcinoma (about 80–90% of primary vaginal cancers)[61], adenocarcinoma, melanoma, sarcoma, metastatic
Iatrogenic / otherMesh-related, pseudocysts, abscesses

Part I — Benign Cystic Lesions​

Müllerian cysts​

  • Most common type in Pradhan's 43-cyst pathology series (44% of 43 cysts in Pradhan 1986; about one-third in Deppisch 1975, where inclusion cysts were the most frequent type)[4][3]. Rankings vary with the sampled population[3][4]
  • Embryology. Paramesonephric (Müllerian) duct remnants; lined by mucus-secreting endocervical-type or ciliated tubal-type epithelium[3][4]
  • Location. Typically anterolateral vaginal wall
  • Presentation. Often larger and more symptomatic than other vaginal cysts; pelvic pressure, dyspareunia, palpable mass
  • Diagnosis. Examination and MRI for anatomy; histology shows mucicarmine-positive columnar lining[2][3][15]
  • Management. Observation if asymptomatic; excision for symptomatic cysts[2][15]

Gartner duct (mesonephric) cysts​

  • Embryology. Mesonephric (Wolffian) duct remnants; non-mucus-secreting cuboidal or low columnar epithelium[3]
  • Prevalence. 5–11% of vaginal cysts (most lesions historically called Gartner duct cysts have mucin and are actually Müllerian)[3][4]
  • Location. Anterolateral vaginal wall along the mesonephric remnant[16][17]
  • Presentation in a surgical series. 38% were asymptomatic; symptoms included dyspareunia or pain with tampon placement (38%), pelvic pain or pressure (24%), pelvic mass or bulge (17%), and urinary incontinence (7%); mean size 3.5 cm[18]
  • Diagnostic pitfall: large Gartner duct cysts can mimic anterior compartment prolapse (cystocele); consider the diagnosis when prolapse compartments don't add up[5][16]
  • Associated GU anomalies in about 10% of a 29-patient surgical series and 19 of 92 (21%) surgically managed patients in a literature review: ipsilateral renal agenesis, uterine didelphys, septate vagina, urethral diverticulum, ectopic ureter; reflects shared mesonephric origin[9][17][18]
  • Renal agenesis, HWW and OHVIRA link. A paravaginal cystic mass with an absent or dysplastic ipsilateral kidney may be a Gartner duct cyst, an ectopic ureter or blind hemibladder, or an obstructed hemivagina (Herlyn-Werner-Wunderlich syndrome: uterus didelphys, obstructed hemivaginal septum, ipsilateral renal agenesis), and the two can coexist. In 26 girls with renal agenesis or dysplasia and pelvic cystic lesions, 9 had Gartner duct cysts, 3 HWW and 3 both. Image the uterus, vagina and kidneys (MRI or 3D ultrasound), especially for cyclic pain or continuous wetting at puberty; excising a septum relieves an obstructed hemivagina. Evidence is case reports and small series[49][50][51]
  • Workup. Exam and transvaginal US (most common); MRI for complex or large lesions or to exclude urologic involvement[16][18]

Management options: Small, heterogeneous series provide no reliable comparison of management techniques.[17][18]

ApproachNotes
ObservationAsymptomatic
ExcisionMost commonly reported; 4/50 recurred in a review [17]
MarsupializationAlternative; 0/14 recurred in that review [17]
Tetracycline sclerotherapy after aspiration1/15 recurred in that review [17]
Unroofing / partial excision0/9 recurred in that review [17]
Fluorescein dye-assisted excisionSingle-case adjunct to delineate walls and assess communication[17]
CO₂ laser fenestration and lining vaporizationThe cyst is opened and the epithelial lining vaporized with a CO₂ laser, then closed with a running locked suture; for a large cyst that cannot be fully removed, the residual lining is vaporized before reapproximating the vaginal wall. Described by Baggish; no comparative outcome data[55]

In the 29-patient series (excision in 26, marsupialization in 3; median follow-up 82 mo), 1 possible recurrence (3.4%) and no intraoperative complications[18]. Two of 11 asymptomatic patients were operated on for interval growth.[18] Before excising a large or complex Gartner duct cyst, its relationship to the bladder and ureter should be defined, with ureteral catheterization used when needed.[55]

Epidermal inclusion (squamous inclusion) cysts​

  • Second most common in Pradhan (23%); the most frequent type in Deppisch, usually clinically insignificant[3][4]
  • Etiology. Acquired; squamous epithelium implanted at episiotomy, vaginal laceration, or prior surgery[3][4]
  • Location. Posterior or lateral vaginal wall, often at episiotomy scars
  • Histology. Keratinizing stratified squamous epithelium with keratinous debris
  • Management. Observation; simple excision if symptomatic; usually benign; atypical or changing lesions warrant reassessment[2][3]

Bartholin duct cysts and abscesses​

  • Anatomy. Bartholin glands at posterolateral introitus (4 and 8 o'clock)[19]
  • Lifetime risk. About 2% of women develop a cyst or abscess[19]
  • Pathophysiology. Ductal obstruction leads to cyst; secondary infection leads to abscess.
  • Antibiotics. Antibiotics are not routinely needed for an uncomplicated cyst or abscess without cellulitis, urinary tract infection, or sexually transmitted infection.[19]

Management. No single technique is proven superior. In a 161-woman RCT, 1-year recurrence was 12% with Word catheter versus 10% with marsupialization (RR 1.1, 95% CI 0.64–1.91)[52]; a 2024 meta-analysis of 735 patients (2 RCTs, 2 observational) found about 7.6% versus 9.4% (OR 0.99, wide CI)[53]. The catheter was placed faster and needed less analgesia. Trials of marsupialization versus silver nitrate or cavity closure were too small to conclude.[19][20][52][53]

TechniqueNotes
Word catheterOffice-based; 4–6 weeks for fistulization; recurrence was 12% at one year in the WoMan randomized trial and approximately 7.6% in the four-study meta-analysis. Contraindicated in patients with latex allergy; fistulization is unsuitable for deep cysts.[19][52][53]
MarsupializationPermanent drainage tract; recurrence about 9–10% in the same data; more analgesia and longer time from diagnosis to treatment [52][53]
Silver nitrate sclerotherapyChemical ablation of the cyst lining; local burns, edema, hematoma, and scarring are possible.[19]
I&D / aspiration aloneHigher recurrence — not first-line
Gland excisionSelected recurrent disease; a new Bartholin-region mass at age ≥40 warrants tissue assessment to exclude carcinoma, not automatic gland excision[47][2][19]

Skene gland (paraurethral) cysts​

  • Embryology. Skene glands are homologs of the male prostate; lined by transitional epithelium[21][22][23]
  • Location. Periurethral, adjacent to the meatus[22][24][25]
  • Frequency in a selected series. Skene cysts or abscesses accounted for 30.2% of 126 periurethral or anterior-wall masses in one referral or treatment cohort.[1]
  • Presentation. Dyspareunia (40%), recurrent UTI (40%), vaginal mass, voiding dysfunction, urinary spraying[23][25]
  • Diagnostic pitfall. Frequently mislabeled as Bartholin cyst; the discriminator is location (periurethral versus posterolateral introitus).[24][25]
  • Management. Observe asymptomatic benign-appearing lesions; excision or marsupialization for symptoms, with urethral evaluation when indicated. No recurrences occurred in one 10-patient excision series at mean 3.5 yr[25]

Endometriotic cysts​

  • about 7% of vaginal cysts[4]
  • Location. Posterior fornix (most common vaginal endometriosis site) or episiotomy scar[8][4]
  • Presentation. Cyclical pain, dyspareunia, dysmenorrhea, tender nodule that enlarges with menses
  • Diagnosis. Exam, transvaginal US, MRI for deep infiltrating disease[8]
  • Management. The DGGG/OEGGG/SGGG expert-consensus guideline advises observation for asymptomatic vaginal or rectovaginal endometriosis without foreseeable clinical harm, and complete resection when symptoms do not improve sufficiently with drug therapy; it describes excision as the treatment of choice for endometriosis in a cutaneous scar.[62]

Ectopic ureter / megaureter presenting as a "vaginal cyst"​

A vaginal-wall cyst with continuous leakage can reflect an ectopic ureter or megaureter; three of five women with vaginal ectopic ureters in one case series lacked typical incontinence.[9][56] Urinary tract imaging is needed to define the ectopic insertion and renal anatomy; ultrasound, MR urography, and CT urography can each contribute.[56] Define the ureteral insertion and ipsilateral renal or renal-moiety function before selecting treatment. In a five-case series, functioning units underwent ureteral reimplantation, atrophic or absent units underwent removal, and one asymptomatic patient was observed.[56] Nephroureterectomy with distal ureter marsupialization was described in a separate adult case.[9] In a pediatric diagnostic-accuracy series of 22 MR urography examinations, 19 investigated suspected ectopic ureter. For ectopic-ureter identification, sensitivity was 88.8–100%, specificity 70–90%, positive predictive value 75–88.8%, and negative predictive value 90–100% against surgical and cystoscopic findings.[54]

Part II — Benign Solid Vaginal Masses​

In a five-year single-center series, 65 of 4,157 women undergoing urogynecologic surgery (1.6%) had surgery specifically for benign perivaginal masses.[6]

Vaginal leiomyoma​

  • Classically the most frequent benign solid vaginal tumor, though uncommon in practice; smooth muscle origin[6][8]
  • Painless mass, dyspareunia, urinary symptoms; well-circumscribed, homogeneous on MRI
  • Excision for symptomatic lesions

Fibroepithelial stromal polyp​

  • Benign polypoid lesion of vaginal or vulvar stroma; pedunculated or sessile[10][11]
  • Can be large and edematous, mimicking aggressive angiomyxoma; important diagnostic pitfall[26]
  • Simple excision is curative

Angiomyofibroblastoma (AMFB)​

  • Benign mesenchymal tumor of vulvovaginal region; clinically often mistaken for Bartholin cyst[27]
  • Well-circumscribed; alternating hypercellular / hypocellular zones with abundant capillary-type vessels; vimentin+ diffusely; desmin and smooth-muscle actin positive in only a minority in some series (negative for actin in the original description)[27][28]
  • Low recurrence after complete excision. Distinguish from infiltrative aggressive angiomyxoma[27][29]

Aggressive angiomyxoma (AAM)​

  • Locally aggressive mesenchymal neoplasm of pelvis or perineum in reproductive-age women (mean about 38 yr)[12][30][31]
  • Infiltrative without a true capsule (distinguishes it from AMFB)[12][27][29]
  • ER+, PR+, desmin+, vimentin+, variable SMA[30][31]
  • Recurrence 30–40%, sometimes years to decades after excision[12]
  • Metastasis is exceptionally rare; local recurrence drives management[12][29]
  • Management. Wide excision with clear margins is the primary approach when feasible without undue morbidity. For receptor-positive bulky, residual, or recurrent disease, GnRH agonists, SERMs, or aromatase inhibitors have been described before surgery or as selective adjuncts; routine adjuvant use and optimal duration are unestablished. Long-term surveillance is needed because recurrence can occur years after excision.[12][30][31]

Other rare benign solid tumors​

Cellular angiofibroma, superficial (cervicovaginal) myofibroblastoma, mammary-type myofibroblastoma: the genital stromal-tumor family; all benign with low recurrence after excision.[10][11]

Solitary fibrous tumor​

A 66-woman perivaginal surgical series included a solitary fibrous tumor among excised masses.[6] In a separate 25-case female-genital-tract solitary fibrous tumor pathology series, 11 tumors had malignant histology by mitotic count; only one tumor in that series was vaginal.[63]

Part III — Vaginal Intraepithelial Neoplasia (VAIN)​

Definition and epidemiology​

  • VAIN is the HPV-related premalignant condition of vaginal squamous epithelium, analogous to CIN and VIN[13][32][14]
  • Rare. < 1% of female genital intraepithelial neoplasias[32]
  • Terminology: VAIN 1 (LSIL) versus VAIN 2/3 (HSIL)[14]
  • Progression to invasive carcinoma. High-grade VaIN can progress to invasive cancer.[14][33] Treated VaIN 2/3 cohorts summarized in the 2023 consensus reported invasive cancer in 3.2–5.8%; Rome et al. observed 8/100 high-grade cases progressing after no treatment (2), treatment failure (5), or late recurrence (1).[33][48]
  • Mean age at diagnosis about 55 years[34]

Risk factors​

HPV (especially HPV 16 and 31), prior CIN or cervical cancer, prior hysterectomy (especially for CIN or cancer; 20–55% of VAIN patients have had prior hysterectomy), immunosuppression (HIV), prior pelvic radiation, smoking.[13][14][33][34][35]

Location: > 80% involve the vaginal vault (post-hysterectomy) or upper vagina.[33]

Management[13][32][33][36][37][38][39]​

Grade / optionNotes
VAIN 1 (LSIL)Observation preferred — a review reported spontaneous regression in up to 81% of expectantly managed VaIN lesions, most of which were low grade; a small series found regression in 7/8 VaIN 1 cases.[33][37]
VAIN 2/3 (HSIL)Active treatment indicated
CO₂ laser ablationFor high-grade VaIN, the consensus reports 73.5–86% cure after one CO₂ laser vaporization.[48] In a 116-woman retrospective series (median follow-up 49.5 months), 75% regressed after the first laser and 23% of those with initial regression recurred. Regression was 52.9% after the second and 26.5% after the third-or-later laser; the authors advise considering another modality if disease fails to regress after two sessions.[39] Exclude invasion with multiple directed biopsies before ablation, and ablate only when the entire abnormal area is visible.[48] Ablation is less suitable for vault disease after hysterectomy for CIN 3, where epithelium can be buried in the vaginal scar.[48]
Surgical excision (local; upper vaginectomy)Mainstay if invasion cannot be excluded; disease-free after excision in 66–81% of reported VaIN 3 series; margins do not reliably predict residual disease [48]
Intravaginal imiquimodAcross heterogeneous VaIN series, imiquimod or 5-FU had reported cure rates of 25–98%; the 2023 consensus favors imiquimod among topical agents for persistent or multifocal disease after invasion is excluded; for VaIN buried in a vaginal cuff scar after hysterectomy for cervical HSIL, surgical treatment is preferable because topical agents cannot reach that epithelium.[37][48] In a 2016 pilot RCT of 30 women with VaIN 2/3 (16 weeks), HPV clearance was 5/8 with imiquimod, 1/9 with laser, and 1/6 with observation; histologic regression to VaIN 1 or less was 8/10, 10/10, and 6/9, respectively.[38] In a 2025 RCT of 56 women with vaginal HSIL, 12.5-mg intravaginal imiquimod suppositories for eight weeks yielded regression to LSIL or normal in 21/27 (77.8%) versus 14/26 (53.8%) with laser by six months (per-protocol; p = 0.07); 10/27 imiquimod recipients reported vulvar irritation, 8/27 fever, and 2/27 discontinued treatment for adverse effects, while long-term recurrence was not measured.[57]
Topical 5-fluorouracilHistorical option; ESGO/ISSVD/ECSVD/EFC consensus discourages use[48]
BrachytherapyReported disease-free survival 86.37–90%[48]; refractory/multifocal disease or poor surgical candidates; reserved due to toxicity

Recurrence and progression: In a 323-woman retrospective high-grade VaIN series, 71/323 (22.0%) had vaginal HSIL recurrence over a median 62.4 months; prior hysterectomy and excisional treatment were independent risk factors, while VaIN 3 was significant only in univariate analysis[34]. Five/323 (1.55%) developed invasive cancer after a median 87.1 months.[34] In a 2026 meta-analysis of 15 retrospective VaIN 2+ studies, a pooled five-study analysis associated immunosuppression with recurrence (RR 2.01, 95% CI 1.12–3.60).[59] Continue long-term surveillance after treated high-grade disease.[39][48]

Part IV — Primary Vaginal Cancer​

Overview​

  • Primary vaginal cancer is rare (about 1–2% of gynecologic malignancies); establish vaginal origin after excluding cervical or vulvar cancer and metastasis from another primary site.[40][41][42][43][14][58]
  • Histology. Squamous cell carcinoma 85–90%; adenocarcinoma; melanoma; sarcoma[41][14]
  • HPV-associated (predominantly HPV 16) in most squamous cell carcinomas[14]
  • Mean age sixth decade; rising incidence in younger women with high HIV prevalence[41][42]
  • Presentation. Vaginal bleeding (most common), discharge, palpable mass, dyspareunia, urinary symptoms[42][44]

Treatment (NCCN Guidelines)[14][40]​

FIGO (2009) staging is clinical: I confined to the vaginal wall; II into subvaginal tissue, not the pelvic wall; III to the pelvic wall; IVA bladder or rectal mucosa or beyond the true pelvis; IVB distant metastasis.[42] MRI is preferred for local extent. For regional and distant staging, the 2023 ESTRO/ESGO/SIOPe guideline recommends CT of the chest, abdomen, and pelvis first and considers PET/CT for additional information, especially in locally advanced disease; ACR also rates PET/CT as usually appropriate for initial staging.[43][58]

StageApproach
IDefinitive radiation is the usual organ-sparing approach — EBRT + brachytherapy ± concurrent platinum-based chemotherapy. Surgery is considered for selected T1N0M0 tumors up to 2 cm and away from the urethra or anal canal when negative margins are feasible without excessive morbidity; (partial) colpectomy includes pelvic-node assessment for upper two-thirds lesions or inguinal-node assessment for lower-third lesions.[58]
II–IVAConcurrent platinum-based chemoradiation plus brachytherapy. For T4a tumors with fistulation, the 2023 ESTRO/ESGO/SIOPe guideline recommends considering GI and GU diversion before chemoradiotherapy (level IV evidence, grade A).[58]
SurgeryReserved for cases where complete resection with clear margins avoids the need for adjuvant RT; definitive surgical management is uncommon

Brachytherapy is a component of definitive radiation; retrospective associations support its use, without proving the size of a causal survival benefit.[44]

Survival in an epithelial-cancer cohort: In a Mayo retrospective series of 124 patients with primary vaginal squamous, adenocarcinoma, or adenosquamous carcinoma, 5-year disease-specific survival was 84.3%, 73.7%, 78.7% and 26.5% for stages I–IV; the corresponding progression-free survival was 58.7%, 59.4%, 67.3% and 31.8%[44][45].

Other rare vaginal malignancies​

HPV-associated adenocarcinoma, clear cell carcinoma (historically DES-associated), endometrioid carcinoma, mesonephric adenocarcinoma, carcinosarcoma, neuroendocrine carcinoma, adenocarcinoma of Skene-gland origin, adenosarcoma, germ cell tumors.[14]

Part V — Diagnostic Approach​

The single most useful diagnostic clue is anatomic location.[2][6][7][8][22]

LocationTop differentials
Anterolateral wallMüllerian cyst, Gartner duct cyst
Periurethral / suburethralUrethral diverticulum, Skene gland cyst
Posterolateral introitus (4–8 o'clock)Bartholin duct cyst
Posterior fornixEndometriotic cyst
Episiotomy scarEpidermal inclusion cyst

Workup:

  1. History. Duration, mass sensation, dyspareunia, discharge, voiding dysfunction, incontinence, obstetric history (episiotomy, lacerations), prior pelvic surgery, menstrual cyclicity, age
  2. Examination. Location, mobility, tenderness, consistency (cystic versus solid), fixation 3.[6][8] Transvaginal or transperineal ultrasound. Can help assess a suspected vaginal mass when imaging is needed[6][8] 4.[8][15][16] MRI pelvis. Characterizes complex anatomy and local disease extent[8][15][16]
  3. Suspected urethral diverticulum. Use pelvic MRI for diagnosis and anatomic mapping ; VCUG, urethroscopy, or ultrasound may add information in selected cases.[7][60] 6.[6][25] Cystourethroscopy. Selected periurethral lesions or operative planning[6][25]
  4. Biopsy. Suspicious, fixed, bleeding, growing or otherwise atypical lesions; age ≥40 specifically lowers the threshold for a new Bartholin-region mass[2]

Management Principles​

MRI, cystoscopy, biopsy and intervention are selected according to symptoms, examination and diagnostic uncertainty.[46]

  • Asymptomatic benign cysts. Observation with periodic follow-up[2][18]
  • Symptomatic vaginal-wall cysts. Excision is commonly used; marsupialization is an option for selected Gartner duct cysts.[2][17][18] For a Bartholin duct cyst or abscess, Word catheter or marsupialization are primary drainage options; reserve gland excision for selected recurrent or large lesions.[19][52][53]
  • Periurethral masses. Establish urethral relationships before surgery using examination and selected imaging or endoscopy. In a 126-patient referral series, patient-reported de novo SUI occurred in 5/89 women without baseline SUI (5.6%), and baseline SUI resolved in 25/37 women with baseline SUI (67.6%).[1]
  • Solid benign tumors. Distinguish AMFB (usually benign, low recurrence) from AAM (locally aggressive, 30–40% recurrence)[12][27]
  • VAIN. Observe VaIN 1 and co-test at 12 months; after a negative co-test, VaIN-specific follow-up may stop if no prior HSIL or cancer requires continued surveillance. Treat VaIN 2/3 with laser, excision, or selected topical therapy; assess with cytology and HPV testing at six months, again at 12 months if response is complete, then continue annual cytology or co-testing every 2–3 years if response remains complete at 12 months; positive HPV or abnormal cytology prompts vaginal colposcopy, with biopsy of abnormal colposcopic findings.[13][32][39][48]
  • Malignancy. Biopsy any suspicious lesion; refer to gynecologic oncology; vaginal cancer is treated predominantly with chemoradiation and brachytherapy[14][40]

Key Principles​

  • Most vaginal cysts are benign and need no intervention unless symptomatic[2][7]
  • Location is the most important diagnostic clue[3][4]
  • Gartner duct cysts can mimic cystocele. Consider when prolapse compartments are inconsistent[5][16]
  • Associated GU anomalies. About 10% of 29 surgically managed Gartner cyst patients and 19/92 (21%) cases in a surgical literature review had associated anomalies; both estimates come from selected surgical populations[18][17]. Assess the upper tract when a congenital anomaly is suspected.[17][18][49][50][51]
  • Rule out malignancy. Biopsy suspicious lesions and assess a new Bartholin-region mass at age ≥40; 1.6% malignancy was observed in one selected periurethral or anterior-wall mass series[1][2]
  • MRI is the primary imaging study for complex vaginal masses[8][15][16]
  • Aggressive angiomyxoma can resemble a benign vaginal mass; Dellino et al. report 30–40% local relapse across pelvic and perineal AAM, sometimes years after excision, and advise the widest feasible excision without undue morbidity and long-term surveillance[12][31]

See Also​

Videos​

Bartholin Cyst Marsupialization
Shashank Parulekar (2020)

References​

1. Jacox N, Yao HH, Baverstock R, Trpkov K, Carlson K. "Periurethral and anterior vaginal wall masses: etiology, presentation, and treatment outcomes." Obstet Gynecol. 2022;140(5):778–783. doi:10.1097/AOG.0000000000004956

2. Aldrich ER, Pauls RN. "Benign cysts of the vulva and vagina: a comprehensive review for the gynecologic surgeon." Obstet Gynecol Surv. 2021;76(2):101–107. doi:10.1097/OGX.0000000000000858

3. Deppisch LM. "Cysts of the vagina: classification and clinical correlations." Obstet Gynecol. 1975;45(6):632–637. doi:10.1097/00006250-197506000-00007

4. Pradhan S, Tobon H. "Vaginal cysts: a clinicopathological study of 41 cases." Int J Gynecol Pathol. 1986;5(1):35–46. doi:10.1097/00004347-198603000-00004

5. Esber A, Radosa MP, Wickel J, et al. "Vaginal cysts: an important differential diagnosis in the anterior compartment." Eur J Obstet Gynecol Reprod Biol. 2021;267:280–284. doi:10.1016/j.ejogrb.2021.11.422

6. Liaci AL, Boesmueller H, Huebner M, Brucker SY, Reisenauer C. "Perivaginal benign masses: diagnosis and therapy in a series of 66 women." Arch Gynecol Obstet. 2017;295(2):367–374. doi:10.1007/s00404-016-4234-3

7. Eilber KS, Raz S. "Benign cystic lesions of the vagina: a literature review." J Urol. 2003;170(3):717–722. doi:10.1097/01.ju.0000062543.99821.a2

8. Pulappadi VP, Manchanda S, Dhamija E, Jana M. "Multimodality imaging of diseases of the vagina." Br J Radiol. 2024;97(1155):513–525. doi:10.1093/bjr/tqad052

9. Eubanks AA, Gonzalez HM. "Congenital megaureter presenting in an adult as a vaginal wall cyst." Obstet Gynecol. 2016;127(5):859–861. doi:10.1097/AOG.0000000000001357

10. Schoolmeester JK, Fritchie KJ. "Genital soft tissue tumors." J Cutan Pathol. 2015;42(7):441–451. doi:10.1111/cup.12507

11. Chapel DB, Cipriani NA, Bennett JA. "Mesenchymal lesions of the vulva." Semin Diagn Pathol. 2021;38(1):85–98. doi:10.1053/j.semdp.2020.09.003

12. Dellino M, Magazzino F, Domenici L, et al. "Aggressive angiomyxoma of the lower female genital tract: a review of the MITO Rare Tumors Group." Cancers. 2024;16(7):1375. doi:10.3390/cancers16071375

13. Suchońska B, Ługowski F, Papież M, Ludwin A. "Vaginal intraepithelial neoplasia (VaIN) — a retrospective cohort analysis of epidemiology, risk factors, and management in an academic clinical center." J Clin Med. 2025;14(15):5386. doi:10.3390/jcm14155386

14. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology — Vaginal Cancer. Updated 2025-12-04.

15. Wai CY, Corton MM, Miller M, Sailors J, Schaffer JI. "Multiple vaginal wall cysts: diagnosis and surgical management." Obstet Gynecol. 2004;103(5 Pt 2):1099–1102. doi:10.1097/01.AOG.0000121827.75677.a4

16. Davidson ERW, Barber MD. "A Gartner duct cyst masquerading as anterior vaginal prolapse." Obstet Gynecol. 2017;130(5):1039–1041. doi:10.1097/AOG.0000000000002315

17. Niu S, Didde RD, Schuchmann JK, Zoorob D. "Gartner's duct cysts: a review of surgical management and a new technique using fluorescein dye." Int Urogynecol J. 2020;31(1):55–61. doi:10.1007/s00192-019-04091-9

18. Cope AG, Laughlin-Tommaso SK, Famuyide AO, et al. "Clinical manifestations and outcomes in surgically managed Gartner duct cysts." J Minim Invasive Gynecol. 2017;24(3):473–477. doi:10.1016/j.jmig.2017.01.003

19. Omole F, Kelsey RC, Phillips K, Cunningham K. "Bartholin duct cyst and gland abscess: office management." Am Fam Physician. 2019;99(12):760–766. PMID 31194482

20. Illingworth B, Stocking K, Showell M, Kirk E, Duffy J. "Evaluation of treatments for Bartholin's cyst or abscess: a systematic review." BJOG. 2020;127(6):671–678. doi:10.1111/1471-0528.16079

21. Kimbrough HM, Vaughan ED. "Skene's duct cyst in a newborn: case report and review of the literature." J Urol. 1977;117(3):387–388. doi:10.1016/s0022-5347(17)58470-0

22. Zuo SW, Napoe GS. "Evaluation and management of urethral and periurethral masses in women." Curr Opin Obstet Gynecol. 2023;35(6):517–524. doi:10.1097/GCO.0000000000000914

23. Miller EV. "Skene's duct cyst." J Urol. 1984;131(5):966–967. doi:10.1016/s0022-5347(17)50732-6

24. Woo I, Birsner ML, Chen CC. "Periurethral cystic mass misdiagnosed: a case report." J Reprod Med. 2014;59(7-8):414–416. PMID 25098033

25. Foster J, Lemack G, Zimmern P. "Skene's gland cyst excision." Int Urogynecol J. 2016;27(5):817–820. doi:10.1007/s00192-015-2872-9

26. Harkness R, McCluggage WG. "HMGA2 is a useful marker of vulvovaginal aggressive angiomyxoma but may be positive in other mesenchymal lesions at this site." Int J Gynecol Pathol. 2021;40(2):185–189. doi:10.1097/PGP.0000000000000689

27. Fletcher CD, Tsang WY, Fisher C, Lee KC, Chan JK. "Angiomyofibroblastoma of the vulva: a benign neoplasm distinct from aggressive angiomyxoma." Am J Surg Pathol. 1992;16(4):373–382. doi:10.1097/00000478-199204000-00006

28. Magro G, Righi A, Caltabiano R, Casorzo L, Michal M. "Vulvovaginal angiomyofibroblastomas: morphologic, immunohistochemical, and fluorescence in situ hybridization analysis for deletion of 13q14 region." Hum Pathol. 2014;45(8):1647–1655. doi:10.1016/j.humpath.2014.03.020

29. Granter SR, Nucci MR, Fletcher CD. "Aggressive angiomyxoma: reappraisal of its relationship to angiomyofibroblastoma in a series of 16 cases." Histopathology. 1997;30(1):3–10. doi:10.1046/j.1365-2559.1997.d01-556.x

30. Yu BR, Choi WK, Cho DH, Lee NR. "Aggressive angiomyxoma of the vagina: a case report and literature review." Medicine (Baltimore). 2025;104(4):e41287. doi:10.1097/MD.0000000000041287

31. Qu H, Liu N, Liang H, et al. "Aggressive angiomyxoma of female pelvis and perineum: retrospective study of 17 cases." Eur J Obstet Gynecol Reprod Biol. 2024;298:165–170. doi:10.1016/j.ejogrb.2024.05.012

32. Rountis A, Pergialiotis V, Tsetsa P, Rodolakis A, Haidopoulos D. "Management options for vaginal intraepithelial neoplasia." Int J Clin Pract. 2020;74(11):e13598. doi:10.1111/ijcp.13598

33. Rome RM, England PG. "Management of vaginal intraepithelial neoplasia: a series of 132 cases with long-term follow-up." Int J Gynecol Cancer. 2000;10(5):382–390. doi:10.1046/j.1525-1438.2000.010005382.x

34. Gallio N, Preti M, Boldorini R, et al. "High-grade vaginal intraepithelial neoplasia: clinical profile, HPV vaccination status, and treatment outcomes at two Italian referral centers." Vaccines. 2025;13(11):1089. doi:10.3390/vaccines13111089

35. Cho HW, Hong JH, Lee JK. "Detection of high-risk human papillomavirus infection and treatment of high-grade vaginal intraepithelial neoplasia: a single-institution study." Int J Gynaecol Obstet. 2021;154(2):227–232. doi:10.1002/ijgo.13583

36. Benson C, Brooks J, Dhanireddy S, et al. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. IDSA / Office of AIDS Research Advisory Council; 2025.

37. Freitas G, Costa A. "Non-excisional therapeutic modalities in vaginal intraepithelial neoplasia." Eur J Obstet Gynecol Reprod Biol. 2023;284:175–179. doi:10.1016/j.ejogrb.2023.03.014

38. Tainio K, Jakobsson M, Louvanto K, et al. "Randomised trial on treatment of vaginal intraepithelial neoplasia — imiquimod, laser vaporisation and expectant management." Int J Cancer. 2016;139(10):2353–2358. doi:10.1002/ijc.30275

39. He MY, Yu EL, Hui SK, Kung YLF. "Clinical outcomes of laser vaporization for vaginal intraepithelial neoplasia — a 20-year retrospective review." Eur J Obstet Gynecol Reprod Biol. 2022;277:101–109. doi:10.1016/j.ejogrb.2022.08.017

40. Abu-Rustum NR, Campos SM, Amarnath S, et al. "Vaginal cancer, version 2.2026, NCCN Clinical Practice Guidelines in Oncology." J Natl Compr Canc Netw. 2026;24(3):101–126. doi:10.6004/jnccn.2026.0011

41. Westerveld H, Nesvacil N, Fokdal L, et al. "Definitive radiotherapy with image-guided adaptive brachytherapy for primary vaginal cancer." Lancet Oncol. 2020;21(3):e157–e167. doi:10.1016/S1470-2045(19)30855-1

42. Adams TS, Rogers LJ, Cuello MA. "Cancer of the vagina: 2021 update." Int J Gynaecol Obstet. 2021;155(Suppl 1):19–27. doi:10.1002/ijgo.13867

43. Expert Panel on GYN and OB Imaging, Kilcoyne A, Gottumukkala RV, et al. "ACR Appropriateness Criteria® staging and follow-up of primary vaginal cancer." J Am Coll Radiol. 2021;18(11S):S442–S455. doi:10.1016/j.jacr.2021.08.011

44. Yang J, Delara R, Magrina J, et al. "Management and outcomes of primary vaginal cancer." Gynecol Oncol. 2020;159(2):456–463. doi:10.1016/j.ygyno.2020.08.036

45. Chyle V, Zagars GK, Wheeler JA, Wharton JT, Delclos L. "Definitive radiotherapy for carcinoma of the vagina: outcome and prognostic factors." Int J Radiat Oncol Biol Phys. 1996;35(5):891–905. doi:10.1016/0360-3016(95)02394-1

46. SASGOG. Management of Vaginal Cysts. Updated March 2026. Clinical pearl

47. NHS Greater Glasgow and Clyde. Management of Bartholin’s cyst and abscess. Clinical guidance

48. Kesic V, Carcopino X, Preti M, et al. ESGO/ISSVD/ECSVD/EFC consensus statement on the management of vaginal intraepithelial neoplasia. Int J Gynecol Cancer. 2023;33:446–461. doi:10.1136/ijgc-2022-004213

49. Acién P, Acién M, Romero-Maroto J. "Blind hemibladder, ectopic ureterocele, or Gartner's duct cyst in a woman with Müllerian malformation and supposed unilateral renal agenesis: a case report." Int Urogynecol J. 2010;21(3):365–369. doi:10.1007/s00192-009-0952-4

50. Dorais J, Milroy C, Hammoud A, et al. "Conservative treatment of a Herlyn-Werner-Wunderlich müllerian anomaly variant, noncommunicating hemiuterus with Gartner duct pseudocyst." J Minim Invasive Gynecol. 2011;18(2):262–266. doi:10.1016/j.jmig.2010.12.006

51. Shimada K, Matsumoto F, Matsui F, Obara T. "Retrovesical cystic lesions in female patients with unilateral renal agenesis or dysplasia." Int J Urol. 2010;17(6):570–578. doi:10.1111/j.1442-2042.2010.02519.x

52. Kroese JA, van der Velde M, Morssink LP, et al. "Word catheter and marsupialisation in women with a cyst or abscess of the Bartholin gland (WoMan-trial): a randomised clinical trial." BJOG. 2017;124(2):243–249. doi:10.1111/1471-0528.14281

53. Bakouei F, Zolfaghari F, Mirabi P, Farhadi Z, Delavar MA. "Comparison of Word catheter and marsupialization in the management of Bartholin's glands: a systematic review and meta-analysis." J Obstet Gynaecol Can. 2024;46(4):102357. doi:10.1016/j.jogc.2024.102357

54. Figueroa VH, Chavhan GB, Oudjhane K, Farhat W. "Utility of MR urography in children suspected of having ectopic ureter." Pediatr Radiol. 2014;44(8):956–962. doi:10.1007/s00247-014-2905-4

55. Baggish MS. Benign lesions of the vaginal wall. In: Baggish MS, Karram MM, eds. Atlas of Pelvic Anatomy and Gynecologic Surgery. 5th ed. Elsevier; 2021:779-792.

56. Wang Q, Wu Z, Zhang F, et al. "Gynecological diagnosis and treatment of ectopic ureter insertion into vagina: analysis of five cases and a literature review." J Clin Med. 2022;11(21):6267. doi:10.3390/jcm11216267

57. Kiviharju M, Riska A, Kalliala I, et al. "Randomised trial on treatment of vaginal high-grade squamous intraepithelial lesion: self-administered vaginal imiquimod and laser vaporisation." Int J Cancer. 2025;157(7):1458–1464. doi:10.1002/ijc.35497

58. Nout RA, Calaminus G, Planchamp F, et al. "ESTRO/ESGO/SIOPe Guidelines for the management of patients with vaginal cancer." Int J Gynecol Cancer. 2023;33(8):1185–1202. doi:10.1136/ijgc-2023-004695

59. Ługowski F, Papież M, Suchońska B. "Comparative efficacy of treatment methods and risk factors for treatment failure in high-grade vaginal intraepithelial neoplasia: a systematic review and meta-analysis." Cancers (Basel). 2026;18(8):1302. doi:10.3390/cancers18081302

60. European Association of Urology. EAU Guidelines on Non-neurogenic Female LUTS: Disease Management. 2026. Guideline

61. PDQ Adult Treatment Editorial Board. "Vaginal Cancer Treatment (PDQ): Health Professional Version." National Cancer Institute; updated April 3, 2025. Clinical summary

62. Burghaus S, Schäfer SD, Bär KJ, et al. "Diagnosis and Therapy of Endometriosis. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/045, April 2025)." Geburtshilfe Frauenheilkd. 2026;86(2):133–188. doi:10.1055/a-2760-4867

63. Yang EJ, Howitt BE, Fletcher CDM, Nucci MR. "Solitary fibrous tumour of the female genital tract: a clinicopathological analysis of 25 cases." Histopathology. 2018;72(5):749–759. doi:10.1111/his.13430